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Lymphadenectomy with Optimum of 29 Lymph Nodes Retrieved Associated with Improved Survival in Advanced Gastric Cancer: A 25,000-Patient International Database Study

 Yanghee Woo  ;  Bryan Goldner  ;  Philip Ituarte  ;  Byrne Lee  ;  Laleh Melstrom  ;  Taeil Son  ;  Sung Hoon Noh  ;  Yuman Fong  ;  Woo Jin Hyung 
 Journal of the American College of Surgeons, Vol.224(4) : 546-555, 2017 
Journal Title
 Journal of the American College of Surgeons 
Issue Date
Adenocarcinoma/mortality ; Adenocarcinoma/pathology ; Adenocarcinoma/surgery* ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Databases, Factual ; Female ; Gastrectomy* ; Humans ; Kaplan-Meier Estimate ; Lymph Node Excision/methods* ; Male ; Middle Aged ; Multivariate Analysis ; Prognosis ; SEER Program ; Stomach Neoplasms/mortality ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery* ; Treatment Outcome ; Young Adult
BACKGROUND: Gastric adenocarcinoma is an aggressive disease with frequent lymph node (LN) metastases for which lymphadenectomy results in a survival benefit. In the US, the National Comprehensive Cancer Network guidelines recommend D2 lymphadenectomy or a minimum of 15 LNs retrieved. However, retrieval of only 15 LNs is considered by most international guidelines as inadequate. We sought to evaluate the survival benefits associated with a more complete lymphadenectomy. STUDY DESIGN: An international database was constructed by combining gastric cancer cases from the Surveillance, Epidemiology, and End Results program database (n = 13,932) and the Yonsei University Gastric Cancer database (n = 11,358) (total n = 25,289). Kaplan-Meier survival analysis was performed along with Joinpoint analysis to obtain the optimal number of LNs to retrieve based on survival. Prognostic significance of number of nodes retrieved was then confirmed with univariate and multivariate analyses. RESULTS: Analysis for both mean and median survival yielded 29 LNs removed as the Joinpoint. This was confirmed with multivariate analysis, where 15 retrieved LNs cutoff fell out of the model and 29 retrieved LNs remained intact, with a hazard ratio of 0.799 (95% CI 0.759 to 0.842; p < 0.001). Stage-stratified Kaplan-Meier analysis for a cutoff point of 29 LNs also demonstrated a statistically significant improvement in survival. CONCLUSIONS: Joinpoint analysis has allowed for the creation of a model demonstrating the point at which additional dissection would not provide additional benefit. This large international dataset analysis demonstrates that the maximal survival advantage is seen by performing a lymphadenectomy with a minimum of 29 LNs retrieved.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Noh, Sung Hoon(노성훈) ORCID logo https://orcid.org/0000-0003-4386-6886
Son, Tae Il(손태일) ORCID logo https://orcid.org/0000-0002-0327-5224
Hyung, Woo Jin(형우진) ORCID logo https://orcid.org/0000-0002-8593-9214
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